Provider Demographics
NPI:1538926258
Name:MOORE, DEONDRE ANTHONY ALONZO
Entity type:Individual
Prefix:MR
First Name:DEONDRE
Middle Name:ANTHONY ALONZO
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 BELLAMY WAY
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1253
Mailing Address - Country:US
Mailing Address - Phone:202-621-4076
Mailing Address - Fax:
Practice Address - Street 1:909 WAHLER PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4007
Practice Address - Country:US
Practice Address - Phone:202-246-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant